Introduction: For the treatment of renal tumors, minimally invasive nephron-sparing surgery has become increasingly performed due to proven efficiency and excellent functional and oncological outcomes. The introduction of robotics into urologic laparoscopic surgery has allowed surgeons to perform challenging procedures in a reliable and reproducible manner. We present our surgical technique using Robotized 3 dimension laparoscopic approach for nephron sparing surgery.Oncological principle, organ preservation and maximum comfort to the surgeon while doing this complicated surgery which involves precise excision of mass and reconstruction was the aim.
Methods: Forty two years old male patient presented with incidentally detected Right renal mass lesion. He was evaluated with contrast enhanced CT scan of abdomen and found to have right renal midpole mass lesion, features suggestive of renal cell carcinoma. Patient was planned for robotized 3D laparoscopic partial nephrectomy. Four ports transperitoneal approach was made. Right kidney was exposed. Gerota’s fascia was opened and all perinephric fat was removed exposing the parenchyma preserving the fat over tumor site. Renal artery was secured with vascular loop. Partial nephrectomy was done ensuring gross tumor free margin status with robotized scissors. The 360 degree rotation and various angular movement of scissors which was controlled from switches in ergonomic robotic handle which was hassle free and precise. Renorrhapy done with V-LOC continuous suture using Robotized needle holder with same features of scissors gave a perfect renorrhaphy and pressure maintenance by haemolock clips. No stent was placed. Kidney was covered with perinephric fat. The specimen was kept in the bag and retrieved out after extending the port incision. Peritoneal toileting done and drain placed
Results: Operative time was 68minutes and ischemic time was 24 minutes. Blood loss was minimal. Oral intake was started on post operative day 1 and hospital stay was 4 days. There were no intraoperative and postoperative complications
Conclusions: Robotized 3 Dimension laparoscopy is feasible at an affordable cost with good oncological outcome, nephron preservation with maximum comfort to the surgeon and minimal morbidity to patient. Robotized laparoscopic suturing is faster compared to conventional methods allowing least ischemic time.
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